Lung ultrasound as the tool for monitoring community-acquired pneumonia

<bold>Introduction:</bold> Lung ultrasound (LUS) is highly accurate for diagnosing community-acquired pneumonia (CAP), but its value in monitoring and prognosis is less known. This study aims to identify which sonographic parameter can be used for monitoring CAP and predicting in-hospital mortality. <bold>Methods:</bold> Prospective study, including patients having symptoms suggestive of CAP admitted to the pulmonology department. All patients underwent LUS on admission day and between days 5-8, assessing consolidation size, number, and LUS score (ranging 0-36). Only confirmed CAP cases at discharge were included in the final analysis. <bold>Results:</bold> Out of 136 enrolled, 95 had LUS-detected pneumonic lesions and were confirmed CAP at discharge. 8 died before a second LUS, and a total 17 deaths. Initial and second LUS comparisons showed marginal changes in consolidation size (3.68cm(2.50–6.86) vs 3.13cm(1.64–6.27), p=0.009), and lesion count (2(1–3) vs 2(1–2), p=0.017), but more pronounced changes in the LUS score (13(9–17) vs 11(6–18), p=0.002). The initial LUS score predicted in-hospital death with an AUC of 0.651 (sensitivity:52.9%, specificity:73.0%, cutoff:17). The follow-up LUS score improved prediction (AUC:0.812, sensitivity:66.7%, specificity:87.9%, cutoff:21). For each point increase compared to the initial score, the unadjusted OR for death was 1.79 (95%CI 1.14-2.80, p=0.012). An improved LUS score nearly eliminated mortality risk (NPV: 97.4%). <bold>Conclusions:</bold> Compared to consolidation size and number, changes in LUS score were more pronounced, with its trajectory depending on survival, making it a useful sonographic parameter for tracking disease progression. An increase in LUS score should alert clinicians about clinical deterioration.